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General NPI Number Information
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NPI Number | 1609368307
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Entity Type | Organization
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Legal Business Name | ANGELS LIGHT ADDICTION SPECIALISTS LLC
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 1023 PITTSBURGH RD STE 100
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City | UNIONTOWN
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State | PA
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Zip | 15401-8407
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Country | US
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Telephone | 724-550-4544
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Fax | 724-550-4766
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Provider Business Mailing Address
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Address Line | 17201 COLLINS AVE APT 2505
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-3482
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Country | US
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Telephone | 845-217-2480
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Fax | 845-217-2481
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Authorized Official
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Title or Position | VP REVENUE CYCLE
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Name | JOANNE DELEON
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Credential |
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Telephone | 845-217-2480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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